Prevalence of diabetic foot ulcers and health care costs

The average global prevalence of diabetic foot ulcers (DFUs) is 6.3% with an increasing trend. The lifetime risk of a diabetic developing a DFU is between 19% and 34% based on a study by Armstrong and colleagues.1 There are also considerable regional differences in the world, with North America having the highest prevalence of DFUs at 13%, Africa at 7.2%, Asia and Europe at 5.5% and 5.1%, respectively, and Oceania with the lowest at 3.0%.2 Within 5 years of the first occurrence of a DFU, 50% to 70% of patients in the United States will die and 5% will require a major amputation.3 Worldwide, it is estimated that DFUs occur every 1.2 seconds, and amputations are performed every 30 seconds.4 As a result, there is a significant economic burden, with treatment and follow-up costs of DFUs (not including the treatment of diabetes mellitus per se) in North America estimated at $ 9 to 13 billion annually.5,6

Classification of Diabetic Foot Ulcers

DFUs can be described using a wide variety of classifications. The early established and most widely used classification is the Wagner or Wagner-Armstrong classification, which, however, is not sufficiently validated.17 Monteiro-Soares and colleagues recommended that a classification should achieve 3 main clinical aims: to prognosticate, to facilitate communication between health professionals, and to facilitate clinical treatment decision-making. They evaluated 19 different classifications and concluded that currently, no classification sufficiently covers all 3 major purposes to be recommended.17 The investigators, therefore, suggested using the site, ischemia, neuropathy, bacterial infection, area, and depth (SINBAD) score for communication between specialists and the Infectious Diseases Society of America/IWGDF criteria (Table 3) for documentation and infection classification purposes. The Wound-Ischemia-Foot-Infection (WIFI) classification score is useful for assessing vascular perfusion and identifying patients who may benefit from a revascularization intervention.17

Sources - https://www.sciencedirect.com/science/article/pii/S108375152200033X